Change of focus in Health

http://morungexpress.com/change-of-focus-in-health/

The present healthcare system is RCH-centric. RCH stands for Reproductive and Child Health. In National Health Mission, RCH takes the centre stage and all the other national health programs follow far behind. Is it justifiable that RCH is given priority over other health concerns? The answer is both Yes and No. RCH covers a very crucial component in the health needs of a population. Women during childbirth and children are vulnerable to adverse health conditions. The quality of health services is measured by how far the benefits are reaching this group of people. Infant mortality rate is an indicator of the overall human development of a population. Healthy mother means healthy child and healthy child means healthy population. So, it is right that RCH should be focused.

But ideally health services should be free of targets. It should be comprehensive and universal. It is the limitedness of our resources which compels to plan specific and targeted interventions. The result of this is that we have RCH which looks after only women in their reproductive period and children, deafness control program just for deafness, and so on. The drawback is that lots of resources are pooled for some limited interventions. For example, women’s health concerns much more than reproduction but RCH is concentrated only on child birth related events. So, universal health care proponents would argue that such targeted interventions are wastage of resources. If the general health service is strengthened, all types of illnesses whether there is a national health program or not, will be covered.

But the more pressing question for us is, ‘should RCH be top priority in Nagaland?’ Without own resources to work with, we only have to implement what Delhi plans. That is the tragedy that beggars can’t be choosers. A Naga public health specialist remarked that RCH should not be top priority in Nagaland when compared to, say, the North Indian States where maternal and child condition is really bad. There are a lot of cultural and socio-economic determinants variations between us and those States. Our mothers and children are in a relatively better condition and consequently we have lesser mortality rates despite weak health services.

Given that we continue to have limited resources to work with, what health area should our State’s focus be? I would suggest that we increase our focus on Non Communicable Diseases (NCDs). The 4 most common NCDs that come to mind are cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases (there are many more). NCDs have become the leading cause of death globally, being responsible for 68% of all deaths in 2012. NCDs are chronic diseases (often lifelong) and are twice more costly to manage than other diseases. A household having someone with chronic disease increases the risk of falling into poverty by 40%.

The good news and the opportunity for NCD control is that they are preventable. 80% of cardiovascular diseases and stroke, 80% of type 2 diabetes, and over 30% of cancers can be prevented. There are 4 risk factors which are closely linked to the 4 common NCDs. They are all behavioural and modifiable risk factors: Tobacco use, physical inactivity, unhealthy diet (high salt and fats, low vegetables and fruits), and harmful use of alcohol. So, majority of the NCDs are non-medical in origin, and so should be their control. It is everyone’s responsibility. It requires enforcement of legislation (tobacco warnings/tax, food safety), education (health promotion), urban development (cycling/foot path), media and marketing (food advertisement), and control of one’s personal habits (tobacco, alcohol).